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2011-08-22 13:02 >> 209 465 1195 P 5/14 <br /> 1187 VANDERBILT CIR. #2 <br /> C LIFORNIA COOLANT SERYICE MANTECA, CA 95337 <br /> "Y ur California Antifreeze Service Company" OFFICE: 209-239.5587FAX: 209-239-6316 <br /> Transporter EPA*CAR000047187 <br /> SERVICE ORDER: :I v 3 1 <br /> BrammTire�SRY=991266 )?j MANIFEST# <br /> 4905 C1aremorttAve. i Mph Lane <br /> StarlQCr� C k 75207 f <br /> 209-.1.77-9901 1'3 l/�-) <br /> EPA M# C k.L 000196 530 C�iAdtrter# 126Q Contact:Charles B3ka Tenn. NA K "eu: <br /> ISO CCS Prirrti4 5C1f50 A/F i S <br /> ? c) lxaste Arufree::.PidcUp <br /> Tank Serial Numbers: <br /> Non Taxable Sub Total <br /> Taxable Sub TOtal <br /> Tax <br /> TOTAL DUE 120 <br /> WASTE DISPOSAL INFORMATION STATE CODE 221 <br /> 1 NON-RCRA HAZARDOUS WASTE,LI ID(USED OIL I MIXED OIL)'NO PLACARDS REOUIRED' STATE CODE 134 <br /> NON-RCRA HAZARDOUS WASTE,LIQ ID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED' <br /> OTHER: _ <br /> O\ DESIGNATEDTSDF: <br /> U EVERGREEN OIL,INC,: 8880 Sm h Avenue•Newark,CA •CADg80887418•(510)79£-4400 Y <br /> o THERMO FLUIDS: 655 South Ste Ord Way•Sparks,NV 89491 •NV10711 •(775)219-7386 <br /> U DIK DIXON: 7900 Chevroo Way• ><en,CA 95820•CATOW012802•(707)89a-WW <br /> D RAMOS ENVIRONMENTAL: 1516 .River Road•W.Sacramento,CA 95891•CADD44003558'pl6)371-5747 <br /> �NUSET INDUSTRIES: 977 South West.Sett Lake City,UT 84104.UTD9825804s9•(801)977-= <br /> LT <br /> 7 AERNATETSDF; <br /> U CFR: 33210 Weetern Avenue•VnIon Cityp CA 94587•(510)487-8277 <br /> (All Generators/C u stoma rs MUST read the following text.) degree10111V 0`f waft"QefWaj*d to the Ihave dolern,in.dtebe <br /> if I am a large quantity generator.I certify that I have a program In place to reduce U*Volume and orzdisposa currertdy a"M"a to me w hich minimize the present <br /> economically practicable and that I tura eelactsd the precticatrle matted of trsatrt+ra storage, <br /> and future threat to human Itfe and the emrironmert. Or,It I am a small quantlty peneetor,I have made a good f ' minimize my waste generation end eetort the <br /> beat waste manage neott method that Is available to me that I can afford. <br /> HEREBY C �!Ulre NOT MIXED THIS WASTE WITH ANY OTH4R WEE,THAT THE TOTAL HA <br /> UDES ARE LM THAN 1000 P.F•IA• ANO THAT THE WASTE DOFF <br /> •I <br /> N ��'.�.. <br /> •I ER A[iREE TO ACCEPT THE ADDRIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVCR 1QOe RD.M.3OTAL HALIDE3.OR CONTAINS ANY P.C.9 S. / <br /> g'tl <br /> � � / /�• r7� -qDate <br /> Date Driver Signature <br /> Customer S 8nat4 % v -" <br /> - <br /> ---- Print Driver's Name <br /> Print Nemo <br /> All ntumea checks an subject to•$16.00 Service Charge. <br /> All amounta-rot paid within 30 days of Invoice are subleet b 1 712%Intatrtst per month,IQ%annually on unp•ld balance. <br /> It accdum is forwarded to colleatlona and or an attorney customw will be responsible for all oeilactlon and or attomW f0ft• <br />